System and method for multisite steering of cardiac stimuli

A pacing system for dual chamber pacing of a patient, comprising:

• pulse generator means for generating pacing pulses for delivery to the patient's heart, having first pulse means for generating first pacing pulses, said first pulses having controllable respective first magnitude, polarity and phase values, and second pulse means for generating second pacing pulses substantially concurrently with said first pulses, said second pulses having controllable respective second magnitude, polarity and phase values;
• a pacing lead connected to said pulse generator means to receive said first and second pulses, said lead having a distal end portion adapted for positioning proximate to or in the patient's heart, said distal end portion having first and second active electrodes and a common electrode, and connecting means for connecting said first pacing pulses between said first electrode and said common electrode and for connecting said second pacing pulses between said second electrode and said common electrode;
• and
• control means for controlling said pulse generator means to generate respective steered ventricular and atrial pacing pulses, each of which steered pulses is a combination of a said first and a said second pulse, and
• steering means for controlling said first and second pulse means so as to select a first set of values of magnitude, polarity and phase for each of said first and second pulses when said pulse generator generates a ventricular pacing pulse, and a second set of values of magnitude, polarity and phase for each of said first and second pulses when said pulse generator generates an atrial pacing pulse.

A pacing system for dual chamber pacing of a patient comprising:

• pulse generator means for generating pacing pulses for delivery to the patient's heart, having first pulse means for generating first pacing pulses, said first pulses having controllable respective first magnitude, polarity and phase values, and second pulse means for generating second pacing pulses substantially concurrently with said first pulses, said second pulses having respective second magnitude, polarity and phase values independently controllable from the first values;
• a single pass pacing lead, said lead having a distal portion for positioning in a patient's right ventricle and an intermediate portion positioned for floating in the patient's right atrium, said intermediate portion having first and second active electrodes and a common electrode, and at least one pacing electrode positioned substantially at the distal portion of said lead, a proximal end for connecting to said pulse generator means, and connecting means for connecting said first pulse signals to said first electrode and said common electrode and said second pulse signals to said second electrode and said common electrode;
• and
• steering means for controlling said first pulse means with a selected first set of values of magnitude, polarity, and phase and for controlling said second pulse means with a selected second set of values of magnitude, polarity and phase, thereby delivering a steered atrial composite pacing pulse to said patient's right atrium.

A pacing system for generating and delivering steered composite pace pulses to at least a plurality of sites in a patient's heart, comprising:

• generator means, comprising a plurality of generators for delivering respective stimulus pulse components, each of said generators having outputs controllable with respect to at least the amplitude and polarity of its pulse component;
• electrode means for providing a plurality of electrodes at different respective cardiac positions in the patient's heart, said electrode means providing at least three electrodes constituting two active electrodes and one common electrode at each respective cardiac position;
• a plurality of sense amplifiers for sensing natural heart beat signals from selected ones of said patient positions;
• switch matrix means for connecting selected ones of said generator outputs to respective selected ones of said electrodes, and selected ones of said electrodes to selected ones of said sense amplifiers, said matrix connecting composite stimulus pulses consisting of plural pulse components to selected ones of said positions;
• and
• pulse parameter and timing control means for controlling the connections made by said switch matrix means, whereby selected cardiac sites receive steered composite stimulus pulses and said composite stimulus pulses are timed as a function of sensed patient natural heartbeat signals.

A method of delivering a steered pacing stimulus to at least one site in a patient's heart, comprising:

• storing steering parameter data including at least amplitude and polarity data of at least two pulse components of a steered composite pulse having said at least two components, said at least two components being independently controllable and at least partially overlapping respecting times,
• selecting parameters of said at least two pulse components;
• delivering to said site a composite steered stimulus having said at least two component pulses;
• determining when adjustment of said composite pulse can provide for more effective steering;
• and
• adjusting said steered composite pulse by changing one or more of said selected pulse component parameters.

An implantable pacing system, comprising:

• a multiple electrode lead for pacing a patient's heart having at least two anode electrodes and at least one cathode electrode positioned thereon, said electrodes being spaced from each other with a predetermined geometry, said lead having a proximal end for connecting to a pulse generator and respective conductors connecting the respective electrodes to said proximal end;
• pulse generator means for generating at least two pulse outputs and delivering a first of said outputs between a first of said anode electrodes and said cathode electrode, and for delivering a second of said outputs between a second of said anode electrodes and said cathode electrode, said pulse outputs at least partially overlapping in respect of time and having magnitude, polarity and phase parameters;
• control means for independently controlling each of said pulse outputs with respect to at least one of said pulse parameters, and
• steering means for selecting said at least one pulse parameter for each pulse output so as to generate pulses for steering the delivery of composite steering pulses to an effective site when the electrodes are positioned in the patient's heart.

A pacing system, comprising:

• a multiple electrode lead for pacing a patient's heart having at least two cathode electrodes and at least one anode electrode positioned thereon, said electrodes being spaced from each other with a predetermined geometry, said lead having a proximal end for connecting to a pulse generator and respective conductors connecting the respective electrodes to said proximal end;
• pulse generator means for generating at least two pulse outputs and delivering a first of said outputs between a first of said cathode electrodes and said anode electrode, and for delivering a second of said outputs between a second of said cathode electrodes and said anode electrode, said pulse outputs at least partially overlapping in respect of time and having magnitude, polarity and phase parameters,
• control means for independently controlling each of said pulse outputs with respect to at least one of said pulse parameters, and
• steering means for selecting said at least one pulse parameter for each pulse output so as to generate pulses for steering the delivery of composite steering pulses to an effective site when the electrodes are positioned in the patient's heart.

A pacing system, comprising:

• a multiple electrode lead for pacing in a patient's heart having at least three electrodes of alternating first and second polarities positioned thereon, at least two electrodes having the first polarity, at least one electrode having the second polarity, said electrodes being spaced from each other with a predetermined geometry, said lead having a proximal end for connecting to a pulse generator and respective conductors connecting the respective electrodes to said proximal end;
• pulse generator means for generating at least two pulse outputs and delivering a first of said outputs between a first of said at least two first polarity electrodes and said at least one second polarity electrode, and for delivering a second of said outputs between a second of said at least two first polarity electrodes and said at least one second polarity electrode, said pulse outputs having magnitude, polarity and phase parameters;
• control means for independently controlling each of said pulse outputs with respect to at least one of said pulse parameters, and
• steering means for selecting said at least one pulse parameter for each pulse output so as to generate pulses for steering the delivery of composite steering pulses to an effective site when said electrodes are positioned in the patient's heart.